HIPAA Revised Adjustment Reason Codes

We have completed a review of our mapping to HIPAA Adjustment Reason Codes and Remit/Remark Codes. Below is a Microsoft Excel spreadsheet that reflects the most recent revisions we have made that became effective on May 19, 2014.

Note: CMS has approved new Remittance Advice Remarks Codes effective October 1, 2003. Oklahoma Health Care Authority will implement the CMS approved codes October 1, 2003. You can find the CMS approved codes for October 1, 2003 posted on the Washington Publishing Company site.

Error Codes/Edit Disposition Codes

To help you understand the meaning of the more common error codes, we have developed a list of top reasons why provider claims deny and offered some solutions to correct each problem.

HIPAA Code
(Remittance Advice)

EOB Code
(Website)

Error

Explanation

Resolution

30

0148

procedure code vs. program indicator

CPT or HCPCS code billed is not covered by this client's eligibility Program

Give the appropriate procedure code for the service provided. If you are unsure whether a service is covered, review the fee schedule or utilize the pricing reference file on the secure internet site, or call
(800) 522-0114, option 1 or (405) 522-6205, option 1 in Oklahoma City metro.

30

0250

recipient number not on file

invalid client id number

Verify that the correct client id number is on your claim.

62

0527

dates of service not on PA database

there is not a prior authorization on file for the service rendered

Use the secure internet site, EVS, or call (800) 522-0114, option 1 or (405) 522-6205, option 1 in Oklahoma City metro to verify that there is a prior authorization on file.